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Biotech / Medical : Biotech Valuation -- Ignore unavailable to you. Want to Upgrade?

To: rkrw who wrote (20275)	6/14/2006 10:46:41 PM
From: Biomaven	Read Replies (3) \| Respond to of 52153

It's interesting that my current drug plan (Express Scripts) has now dropped Lipitor from Tier 1 - so I think it costs me about $50 extra every three months to go with Lipitor rather than Zocor, even though ZOcor is not yet generic. I personally suspect Lipitor is likely a bit better than Zocor but nobody really knows now (or will likely ever know). Here's the latest abstract on a comparison across statins - hints that Lipitor is in fact better than the others, but no stat sig (although I'm guessing that att the 10% significance level Lipitor would have proven better, particularly as against Pravachol): Am Heart J. 2006 Feb;151(2):273-81. Related Articles, Links Click here to read Click here to read Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention. Zhou Z, Rahme E, Pilote L. Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada. BACKGROUND: The relative efficacy of different statins for long-term cardiovascular prevention remains largely undetermined. METHODS: Using adjusted indirect comparison, we compared 3 statins (pravastatin, simvastatin, and atorvastatin) based on published randomized placebo-controlled trials for long-term cardiovascular prevention. A systematic literature search between 1980 and 2004 was conducted. Randomized placebo-controlled trials of the 3 statins, which studied cardiovascular diseases or death as the outcome, enrolled > or = 1000 participants, and had > or = 1-year follow-up, were included. Trials were grouped according to the statin under study. A pooled relative risk (RR) was derived from each set of trials using a random-effects model. Adjusted indirect comparisons using pooled RRs were made between statins with regard to prespecified clinical outcomes. RESULTS: Eight placebo-controlled trials met the inclusion criteria, including 4 pravastatin trials (n = 25,572), 2 simvastatin trials (n = 24,980), and 2 atorvastatin trials (n = 13,143). All trials had a similar degree of lipid reduction. Graphical and statistical assessments showed minimal heterogeneity in the trials' effect sizes. Adjusted indirect comparisons did not reveal a statistically significant difference between statins in reducing fatal coronary heart disease and nonfatal myocardial infarctions (simvastatin vs pravastatin: RR 0.93 [95% CI 0.84-1.03]; atorvastatin vs simvastatin: RR 0.84 [95% CI 0.66-1.08]; atorvastatin vs pravastatin: RR 0.79 [95% CI 0.61-1.02]). We were unable to detect differences either in outcomes for fatal and nonfatal strokes, all cardiovascular deaths, and all-cause mortality. CONCLUSION: Evidence from published statin randomized placebo-controlled trials suggests that pravastatin, simvastatin, and atorvastatin, when used at their standard dosages, show no statistically significant difference in their effect on long-term cardiovascular prevention. I don't know how they adjusted for dosing differences across these trials. Peter